A Place For Mom: The Best-Kept Secret in Long-Term Care

First in a series of articles about assisted living, which in many cases is an attractive option for many frail elderly whose physical and cognitive issues aren't severe enough to require nursing-home care, but for whom it is no longer advisable to live alone. In this installment, we will explore the philosophy of AL and the types of services these communities can offer. Nurses Announcements Archive Article

A middle-aged woman tiptoes out of your elderly patient's room as you stand at the computer making your latest entry, then sneaks a look back to make sure her mother is still sleeping. Shyly, she approaches you and whispers, "Do you have a minute?"

You don't, but you close out your charting and tell her that of course you do. "I don't know what I'm going to do with Mom," she sighs, running her fingers through greying hair."This is the fifth time she's fallen in the past two months, and now Dr.Stevens says she can't live alone anymore. She says she won't go to a nursing home, but my husband was diagnosed with lymphoma last spring and I have to take care of him, make sure he gets to his appointments and so on, and I just don't think I can take care of them both."

She seems on the verge of tears as you put a comforting arm around her and push your other projects aside for the moment. Fortunately for her and her mother, you have a working knowledge of the resources in your area for seniors who are no longer safe to live independently, yet not ready or willing to enter a nursing facility. You excuse yourself for a moment and step over to the information center at the discharge planner's desk, where you pick up several pamphlets and hand them to her. "I understand completely," you reassure her. "Here is some information for you about assisted living facilities in our area."

But what is assisted living? you may be asking yourself, particularly if you're not familiar with this type of extended care setting. What sort of care do they provide? How much does it cost? What kind of staffing do they have? And how is AL different from the more traditional nursing home?

First of all, assisted living is arguably the best-kept secret in long-term care, even after some three decades in the LTC industry. More home-like and less restrictive than most nursing homes, assisted living offers the independence seniors want with the services they need in order to stay as healthy as possible given the limitations imposed by disability, cognitive decline and/or chronic illness.

While laws governing such facilities (or "communities", as they are often called) vary from state to state, you'll usually find them warm and welcoming. The buildings themselves are generally well-appointed and decorated handsomely, and staff members are usually available at the front desk to greet you. The focal point of many facilities is a large and well-lit dining room, where most of the residents take their meals in a restaurant-like setting. If you tour the building, you'll find residents living in their own furnished apartments instead of rooming with one or two other people with only thin curtains between them.

The apartments feature private bathrooms with a spacious walk-in shower and grab bars installed in strategic places, as well as kitchenettes with a microwave oven and a small refrigerator. There is wall-to-wall carpeting and a nice, large window to look out of and perhaps even raise a plant or two. All apartments have a separate heating/cooling system and call system, which can be used by the resident to summon help when he or she needs it.

There are also plenty of activities to choose from. The most popular at almost any community is Bingo, followed closely in some locales by MexicanTrain Dominoes and casino trips on the facility bus. Some residents have a community garden where they raise vegetables for dinners and flowers for the tables; others who are less active often like to sit in the library and read, do jigsaw puzzles, or work on the computer.

ALF residents come in all ages, colors, shapes, sizes, and diagnoses. They can range from the fifty-something gentleman with severe mental illness to the 99-year-old grande dame who always smells faintly of lavender and Dove soap. ALF staff take care of sliding-scale diabetics, people with dementia, amputees, ostomees, COPD'ers, stroke patients, even hospice. They give B-12 injections, take care of catheters, change wound dressings, and use compression therapy for lymphedema. And in some parts of the country, they do it all with only one licensed nurse!

In the next article, readers will be introduced to the different staffing models used in ALFs and how nurses and unlicensed staff work together to provide high-quality care at far less cost than the average nursing facility.

Specializes in Orthopedics.

Thanks for the great information! I wonder how outcomes differ in ALF compared to LTC? This is by no means to dog nurses in LTC as I know we all work hard to take care of our patients!!.. Just curious if the patient is more willing to be compliant and feels better feeling that they are in their "home" rather than a "facility."

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

I think it has a lot to do with the patient. Both my mother and mother-in-law are suffering from dementia, so complaince is a day-to-day issue.

And why is this article called "the best kept secret"? The best kept secret is that a person may go into assisted living and be fine for a year but then they need more care and that increases the cost by a huge amount. Paying $400/mo for my dad to be given his 4-5 pills/day (and he paid for the meds) is outrageous. Some assisted living places charge by the pill. One told me it was $5/pill and that included tylenol, etc. And that was a few years ago so maybe it is now $6/pill. The fact of the matter is is that the U.S. is not a good place to be when one becomes old or ill.

Specializes in psych, addictions, hospice, education.

My mom lived in assisted living for the last 15 years of her life. She lived in two different facilities and each had it's good points. Both were lovely and the people who worked there did all they could to help mom be healthy and happy.

The first provided all the care she needed as someone who wanted to maintain as much independence as possible. She got her meals, help with bathing if needed, and her medications dispensed by a nurse. There was a doctor who could be called if needed, and she checked in on people of the nursing staff thought it was needed. Mom's room was a big one where she had her bed on one side and living room furniture on the other. She had her own bath but the shower and tub were down the hallway, so not as private as she would have liked. She didn't have a fridge or a microwave, and couldn't have gotten one or been given one by family. Meals were provided in a big dining room. This facility seemed more like a nursing home outside mom's room than the second place.

The second facility had a lovely large room with a divider between living and sleeping spaces, and a private bath with a shower that could have been used by someone with a wheelchair. It had a kitchenette. The group dining room was beautiful. There was a library and a computer room. There was a big kitchen people could use to cook for their families on special occasions. There were "family" rooms here and there for when the number of visitors was too big for her own room to accomodate. The drawback of this place was there was no nursing staff on duty, ever. There were aides present, but they weren't allowed to do anything remotely medical. They did laundry and cleaned rooms. They were around alot and very very nice to my mom. They could remind people about medications but couldn't open bottles or hand the bottles or medications to people. If someone fell, they couldn't help him or her up. An ambulance had to be called if the person couldn't get up on his/her own.

My mom said she enjoyed both places.

I think it's obvious that anyone would rather live in a ALF over a SNF. It's more like having your own apartment with frequent caregiver, while a SNF is more "institutional". But they are just so expensive. Only the super rich can afford to live in one for any great length of time. It just seems like a why to drain all the money out of the elderly for a couple years (at most) before they go to a LTC to live out the remainder of their lives. I'm sorry if this sounds harsh, but it just seems like an ultra expensive long vacation or something before they finally go to the LTC they were destined for all along....

Specializes in LTC, assisted living, med-surg, psych.

We do everything possible to allow our residents to "age in place", that is to say, we don't kick them out if they go on Medicaid or become a two-person transfer. We also try to keep them even if they go on hospice and would otherwise need more care than we can provide. And as far as costs go, the $4000+/month our highest acuity resident pays is only about two-thirds of what it would cost him to live in a nursing home, which is where he actually belongs (but that's a story for another day).

Most of our residents die in our facility after an average stay of 4 1/2 years. That's pretty good statistically, considering the national average is somewhere around 2 years. Yes, some companies are all about profits, and yes, some facilities are very poor in quality; however, the same can be said for every level of care.

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think it's obvious that anyone would rather live in a ALF over a SNF. It's more like having your own apartment with frequent caregiver, while a SNF is more "institutional". But they are just so expensive. Only the super rich can afford to live in one for any great length of time. It just seems like a why to drain all the money out of the elderly for a couple years (at most) before they go to a LTC to live out the remainder of their lives. I'm sorry if this sounds harsh, but it just seems like an ultra expensive long vacation or something before they finally go to the LTC they were destined for all along....

I'm not sure where you live, but the lovely ALF where my mother stayed was about $1200/month, and most of it was covered by Medicare. My mother had minimal savings, but my sister (the POA) figured she'd have enough to stay there for 7 years before the money ran out. Unfortunately, my mother's dementia progressed beyond their level of care after about 2 and a half years. I'm very grateful for the 2 and a half years Mom was able to stay there. It was a lovely place, and the staff were all very good to my mother and to our family.

I admit, I've never worked in assisted living and I've never had a family member in one, so my knowledge is based on anecdotal evidence. I was under the impression a fairly independent resident paid about $3200 a month. But again, that's just anecdotal. I've only worked in nursing homes, so maybe Im biased.

When I was a little kid, old people went straight to a nursing home where they lived out the rest of their lives. Assisted living just seems like an artificial level of care tacked on before skilled nursing.

But then again, I also thought all ALF were 100% private pay, so I guess I should do some research. I'm sincerely glad for anyone whose family found a happinessin assisted living. And I totally understand the appeal of aging in place and with dignity. No disrespect intended.

Specializes in CRNA, Finally retired.

After her savings were exhausted, she was put on Medicaid. However, she would not have been accepted in the beginning unless she was private pay.

Specializes in Hospice / Ambulatory Clinic.

Don't forget the ALF's that have a special memory care wing. I had a patient in one of those with the most wonderful "wander garden". The whole place reeked of dignity.

Specializes in Med Surg, Parish Nurse, Hospice.

As a staff nurse in a small community hospital, I have cared for many residents of ALF while in the hospital.Some do well, others have no idea of who they are or why they are any where. I would be afraid to leave my loved in a place with minimal staff at night- what about fire? I have talked with several people who have worked in AFL and they were the only staff member present at night. How could 1 person make sure 30 or more folks were safe in an emergency. About 10 yrs ago when my daughter was 16, she got a job working at ALF. Her first day there she set the table for dinner, cleaned toilets and then gave the residents their meds. When she came home and told me that she had given people meds, I almost had a stroke. She wasn't happy, but she did not keep her job. As a RN and mom,I did not feel comfortable with my teenage child giving meds. I guess you just have to check out the individual ALF and go into it with your eyes and ears wide open!

Specializes in LTC, assisted living, med-surg, psych.

It's true, the quality of ALFs varies greatly by location, company, and numerous other factors. In my next article in this series, I'll discuss staffing models such as the "neighborhood" concept, nurse delegation and the duties of the RN, and training requirements for the unlicensed assistive personnel who perform the vast majority of the care and housekeeping tasks for their assigned residents.